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HomeMy WebLinkAbout16541-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy Date March 21, 1988 THIS CERTIFIES that the building RENOVAT I ON Location of Property 27475 Main Road Cutchogue, New York House/Vo. Street Hamlet County Tax Map No. 1000 Section 102 ,..Block 01 .Lot 13 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 16, 1987 16541 Z ..................... pursuant to which Building Permit No ...................... dated .... .O.c.t.o..b .e.r.. ! .9 .,.. I. 9. .8 .7 ..... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... REFRAME & SHINGLE ROOF, NEW BATHROOM PLUMBING & WIRING TO EXISTING ONE FAMILY DWELLING The certificate is issued to ....... ESTHER H. SOULLAS ............... ~oh;,'o',..:~g.~lr;~Xt[.;;~7~ X .................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N842984 - Nov. 12, 1987 PLUMBERS CERTIFICATION DATED: March 11, 1988-PETER SOULLAS-MASTER PLUMBING Rev. 1/81 FORM lqO. O TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) No_ 16541 z Permission is hereby granted to: , ~ ,, ...~..~.....~ ....... ~.~~ ........ ..... 6...o....C....E.~.~.....~. .......................... · :~~~..~.:~..:..!...~...c..~ .......... ~ , at premises located at ..422..2fi ....... lq~.....~....~.: ......... .k~l.~.~ .......................... County Tax Mop No. lO00 Section ...... l..,,~.~ ..... Block ..... ...(~....~ ......... Lot No ...... I...~ ........... pursuant to application dated ....C~.~7..~...)...~. ................. , 19..~...'1.., and approved by the Building Inspector. 'Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory,$IO.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... New C on s t r u c % i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ... ~7.6/f. 7.5....J~'l .~.. J~.. ~f~. ........ ~/.~.~.~,~'0.~'(~.:%,. ~.'./~..' ......... House No. Street Hamlet Owner or Owners of Property ...... . ........................... County Tax Map No. 1000 Section ..... f.~. ~. ...... Block ...... A ....... Lot... ~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No... f.~..~.J~l . Date of Permit J0/'.~.fi~. :Applicant..'.~. ,"/~.~.~.. ,~.., .'~?[~(,x/~.: ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $,. ., ............ Construction on above described building a~,~V~ m~s ~a~p;~le_codes and regulations' App cant .~.~'~ . ,~q.. ~O~.~..' .................... Rev. 10-10-78 6 1. FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & .FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit NO. I~.~1' (please print) (please print) I certify that ~he solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this I~ ~ay of ~ ,' Notary Public, 5%A~Ab;~ County ig umber' s s nature) 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SE?TIC TOWN HALL NO?IFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL Examined .~~. I .~., 19 .~.~. Approved · .O..~. · · .°??qL'~. · · ] .~.., 19~. .'/. Permit No. ]..~.~.~.l. % BOARD OF HEALTH '''~ii~ '~4~ 3 SETS OF PLANS SURVEY .. CHEC¢ ~4.~¢ .... FORM ' Disapproved a/c ..................................... (Building h~.;pector) APPLICATION FOR BUILDING PERMIT Date ................... 19.. INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street or areas, and giving, a detailed description of layout of property must be drawn on the diagram which is part of this appl cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such penn. shall be kept on the premises available for inspection througho.ut the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations; or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws, ordinances, building c~51e~ housing cod, c,~and regulations, and t admit authorized inspectors on premises and in building for necessary inspecti~.4('/~ ......... ....... (Signatrt~'~ 6 ffapplicant, or .naj;ne, j~ a_ corporation) . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general cont.ractor, electrician, plumber or builde' Name of owner of premises..~. ~'~-. · . · ~. ...................................................... (as on the tax roll 6r latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALI, CONTRACTOR'S blUST BE SUFFOLK COIJNT¥ LIC~..NSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................. 2 ....... House Iq'umber Street / Hamlet County Tax Map No. 1000 Section ..... ]..~. ~ ...... Block ...... ..Q~..~ ........ Lot .... 1..~ ........... Subdivision ..................................... Filed Map No ............... Lot .............. ~. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy..~~~ .................... ' ........ : ......... ' ......... b. Intended use and occupancy ....... ~ ........... 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ............. ;.,,Oth0r.3Vork ............... ~ (Descrip.tion) 4. Es ~mti~ated Cost . ..,..~,e-,JTO'D~.i ........................... Fee ~ " (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... .. If garage, number of cars ...i ...................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, ff any: Front.. ............. Rear .............. Depth ............... Number of Stories Height ....................................................................... Dimensions of same structure:with alterations or additions: Front ................. Rear ................. ,. Depth ...................... Height ...................... Number of Stories ..................... ~. Dimensions of entire new construction: Front ' Rear Depth .... '. 9.' Size of lot: Front ......... ~ ............. Rear ............. Depth ' Name of Former Owner ~0 Date of Purchase 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... ..................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .~ ................... Address ................... Phone No ................ Name of Architect ........ ................... Address ................... Phone No ................ Name of Contractor .... ...,...................~ Address .... ; .............. Phone No ................ 15. Is this property locate:d within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Tlrustees Permit may be required, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and blo :k number or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, COUNTY OF ................ :. S.S APPROV~;~ AS NOTED ?~6-1~2 9 AM TO ~ ~ ~R T~ FOLLO~NG INS~CTIONS: ~uNDATION ~WO REQUIRED ~R ~URED ~UGN FRAMING & ~UMBING ~. INSULATION 4~ FINAl CONSTRUCT~ ~U~ BE COMPLETE ~OR C.O. ALL CON8TRUCTION SHALL MEET T~ REQUIREMENTS ~ ~ N.Y ~TA~ CON8TRUC~ & EN~GY n~[~ O~ CONST~CTION ~RRORS. ................................................. being duly sworn, deposes and says that he is the applicant (Name of indivi'dual signing contract) above named. He is the ....................................................................................... i. (Contractor, agent, corporate officer, etc.) of said owner, or owners, and is duly ~iuthorized to perform or have performed the said work and to make and file thi~ application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the- work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... /? ...... dafof ....... ......... NOTARY PUBL C, State of New Yodl ........... -' · NO. 4707878, Suffolk C~unty C~ (Signature of applicant: Term Expires March 30,19_....1,: / .